Last night, Sen. Orrin Hatch (Utah) announced that the Senate Republican tax reform bill would include a repeal of Obamacare’s individual mandate. Why is this a big deal? It all goes back to the profound impact of Congress’ official fiscal scorekeeper, the Congressional Budget Office.
The single most important reason that Republicans failed to replace Obamacare in 2017 is because of estimates by the Congressional Budget Office that 22 million fewer people would have health insurance in 2026 under the GOP bills.
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Medicaid spending and enrollment has skyrocketed in recent years, crowding out resources for all other state priorities. The number of people dependent on Medicaid has more than doubled since 2000, with nearly 75 million individuals currently enrolled in the program. Nowhere is this growth more evident than among able-bodied adults. Nearly 28 million able-bodied adults are now dependent on the program, up from fewer than 7 million in 2000.
This enrollment explosion is fueling a massive spending surge. Total Medicaid spending has nearly tripled since 2000 and spending on able-bodied adults has increased by a jaw-dropping 700 percent.
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Vice President Mike Pence is exerting growing influence over the American health care system, overseeing the appointments of more than a half-dozen allies and former aides to positions driving the White House’s health agenda.
On Monday President Donald Trump nominated Alex Azar, a former Indianapolis-based drug executive and longtime Pence supporter as HHS secretary. If confirmed, Azar would join an Indiana brain trust that already includes CMS Administrator Seema Verma and Surgeon General Jerome Adams. Two of Verma’s top deputies — Medicaid director Brian Neale and deputy chief of staff Brady Brookes — are former Pence hands as well, as is HHS’ top spokesman, Matt Lloyd.
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As Open Enrollment for 2018 coverage gets underway, consumers who have health coverage through the Affordable Care Act (ACA) Marketplace are again receiving renewal notices from their health insurers. Though the insurer renewal notices are based on the same model notice required in the past, this year for many consumers, it may be causing significant – and misleading – sticker shock.
That is because renewal notices sent by insurers are required to inform consumers what their 2018 monthly premium will be, assuming they receive the same amount of advanced premium tax credit (APTC) next year that they did in 2017. Insurer renewal notices have been required to present information this way since 2014.
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The tax-reform bill that Senate Republicans are releasing Thursday does not repeal ObamaCare’s individual insurance mandate, though the provision could be added down the line, GOP senators said.
Senators leaving a briefing about the legislation said repealing the mandate is not in the initial text of the legislation, but cautioned that the issue is still under discussion.
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More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Trump’s assertion that the marketplace was collapsing.
In a report on the first four days of open enrollment, the Trump administration said Thursday, 601,462 people selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.
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The Senate GOP tax bill will retain a key deduction for qualified medical expenses that was excluded from the House version, according to a Republican senator on the Senate Finance Committee.
If you were deliberately trying to design the most arbitrary, painful and pointless tax possible, how would you go about it?
First, you would structure it to inflate the cost of an essential product. Then, you’d create exemptions so vast that only 5% of taxpayers were subject to it. You might even ensure that it hit people only when they were particularly vulnerable—like when they’d lost a job. Finally, you would use it to drive enrollment in entitlements, so that it increased the federal deficit by $338 billion.
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Uncertainty over the future of the Affordable Care Act was a challenge for insurers and state regulators as they prepared for the 2018 plan year. Various insurers exited or reduced service areas in the health insurance marketplaces, while others threatened exits or delayed participation decisions. In several states, some or all counties seemed likely to have no insurance plan available for residents seeking marketplace coverage. But as of the start of open enrollment, no states had counties without an insurer for plan year 2018
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Since the Affordable Care Act health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. Our earlier analyses of insurer participation and some notable company exits can be found here. Note that we consider affiliated insurers serving the same areas as one insurer.
In 2014, there were an average of 5.0 insurers participating in each state’s ACA marketplace, ranging from 1 company in New Hampshire and West Virginia to 16 companies in New York. 2015 saw a net increase in insurer participation, with an average of 6.0 insurers per state, ranging from 1 in West Virginia to 16 in New York. In 2016, insurer participation changed in a number of states due to a combination of some new entrants and the failure of a number of CO-OP plans. In 2016, the average number of companies per state was 5.6, ranging from 1 in Wyoming to 16 in Texas and Wisconsin.
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